Department of Intensive Care, Austin Hospital, Melbourne, Victoria.
J Clin Apher. 2022 Aug;37(4):397-404. doi: 10.1002/jca.21984. Epub 2022 Apr 6.
Therapeutic plasma exchange (TPE) is a blood purification technique removing antibodies and plasma proteins to modulate disease and promote recovery. The procedure has different methods, using a membrane or plasma separator with many elements similar to continuous renal replacement therapy (CCRT) in the Intensive Care Unit (ICU). These nursing knowledge and skill sets apply where ICU nurses are providing TPE with increasing need. However, different care models are also in place where TPE is the responsibility of apheresis and nephrology teams visiting the ICU. The plasma replacement volume and prescribing is aligned with published guidelines but is variable when critical illness overlays the primary indication for TPE. There are some important considerations for TPE with respect to anticoagulation, machine settings, prescribing, and associated nursing management. TPE can be performed concurrent with CRRT in acute situations using Y-piece and valve connectors and is a new and recent advanced blood purification for the ICU.
治疗性血浆置换（TPE）是一种血液净化技术，可去除抗体和血浆蛋白，以调节疾病并促进康复。该程序有不同的方法，使用膜或血浆分离器，其中许多元素与重症监护病房（ICU）中的连续肾脏替代治疗（CCRT）相似。这些护理知识和技能适用于 ICU 护士越来越需要提供 TPE 的情况。然而，也有不同的护理模式，其中 TPE 是访问 ICU 的血浆分离和肾脏病学团队的责任。血浆置换量和处方与已发布的指南一致，但在主要 TPE 适应证之上出现危急病症时，情况则有所不同。TPE 存在一些与抗凝、机器设置、处方和相关护理管理有关的重要考虑因素。在急性情况下，TPE 可以与 CRRT 同时进行，使用 Y 型管和阀连接器，并且是 ICU 中一种新的、最近的先进血液净化方法。
